Think back to the last “big” case you presented. Did the patient move ahead with it? And by that I mean all of it – rather than doing it “bit and piece,” or just “what insurance covered”? How about the one before that? Depending on your success (or lack thereof) on this subject, you may have wondered if there was a series of rules or a winning formula when presenting a big case.
I always loved doing comprehensive treatment plans. And while they were a big production “booster,” what I loved most was how they gave me an opportunity to do the dentistry I enjoyed doing the most.
And while I loved the clinical aspects of big cases, I didn’t love presenting them until I became an MGE client!
Despite our clinical confidence, as the cases get larger most dentists (and this included me at one point) get backed off from presenting full treatment plans —especially with new patients.
Reasons for this vary, and can range from fear of blowing a patient off, worry about a patient thinking we are “after their money,” or just plain being uncomfortable with asking a patient to make that much of an investment in their health. So, in many cases we end up with partial or phased treatment plans, doing only what insurance will cover.
It was with all of this in mind that I decided to write about the subject. Specifically, ten rules I’ve isolated that can make all the difference when presenting a big case. And while these are absolutely vital when presenting big cases, they will also help when presenting routine “bread-and-butter” treatment plans.
In this four-part article, I plan on covering each of these rules in detail. To give you an idea, here is what they are:
- Estimate how much time and effort you’ll need to “close” the patient on the treatment plan.
- Certainty Wins: Be certain you can clinically deliver what you treatment plan and be comfortable with the fee.
- The Exam: Don’t scare the patient away!
- Treatment plan ideal dentistry
- Treatment Options: How to Present Them So Your Patient Understands (and picks what’s best).
- Understanding: The KEY to Case Acceptance.
- Patience…with your patient.
- Know how to address objections.
- The treatment presentation is complete when solid financial arrangements are made.
- Begin the treatment plan quickly.
I’ll cover Rules 1-2 in this part and pick up the rest in the three parts that follow:
IMPORTANCE NOTE: Before I get into the first rule, I want to stress that the overriding foundation of any case presentation is caring for a patient and what is best for them. You should treat every patient as if they were a close friend or relative. This doesn’t mean you have to have them over to the house for a barbeque but you should care that they get the quality care they need to free them of dental disease, which in turn has been proven scientifically to extend their lives.
With that said, let’s start with rule #1:
RULE 1: Estimate how much time and effort you’ll need to “close” the patient on the treatment plan.
What does this mean? Basically, you have to assess how much time it’s going to take to get that particular patient to understand their individual treatment plan, handle any questions, address any concerns and still have time to work out financial arrangements. This sounds complex but it’s easier than you might think.
Let’s start with a clinical example: do you leave the same amount of time for a buccal pit restoration as a crown? Of course not. Do you leave the same amount of time for molar endo and an anterior. Of course not. That wouldn’t work. We adjust the length of the appointment to match the ease or difficulty of the procedure.
We can apply this same concept when presenting treatment. During the exam you have to size up how much time it will take to close the case at the consultation appointment. Two key determining factors would be: 1) The patient’s history with regards to dental care. How often they see the dentist is a good indication as to how important teeth are to them. Someone who comes in regularly is going to be easier to close than someone who hasn’t seen a dentist in ten years. 2) How big is the case? The larger the case, the longer it will take to present it properly.
To help determine their attitude towards dentistry and keeping their teeth you could ask every patient one question:
Do you want to keep your teeth?
This will help you determine a patient’s mind-set with regards to comprehensive treatment. The routine patient that needs a couple of crowns who wants to keep their teeth will not take as much time to present as someone who hasn’t been to a dentist in ten years, but still wants to keep their teeth, that needs $10,000 worth of dentistry. Someone who really doesn’t have keeping their teeth as a priority will take longer still—even if it’s a smaller case.
The rule of thumb is: Don’t start a case presentation if you don’t have adequate time in which to complete it.
If I had a patient who hadn’t seen a dentist in a long time and they needed a lot of treatment I would schedule them for an hour or two (depending on the patient) on a Friday morning when I usually didn’t see patients. Then I wouldn’t be interrupted and could give them my undivided attention. Wherever you schedule it, you MUST be free of distraction or other duties during the presentation (i.e. you’re not getting up to numb a patient in the middle of it). Along with this you must have adequate time to properly present the treatment plan (which includes ample time for Q&A with the patient and so on).
For the patient that sees the dentist regularly we would present and close at the time the treatment was diagnosed. This is not an exact science. It is something you will have to figure out as you go along. In a few weeks you’ll have it under control.
If they say they don’t really want to keep their teeth, you may need to leave time at the consult to handle that first. It’s part of the game of figuring it out.
RULE 2: Be certain you can clinically deliver what you treatment plan and be happy with the fee.
These could be two different items but the point I’m trying to emphasize is that you have to be totally confident that you can deliver the case at a high clinical standard and you have to be comfortable with the fee.
I could see how it might be tempting to do a big case that might be outside your comfort zone clinically; it presents a challenge and has a nice fee attached to it. That said, I can’t count the ways in which this is a Bad Idea. And while this article is not a debate about clinical ethics, beyond the all too obvious problems with doing this, we have another factor. If you aren’t sure you can deliver the procedure at the highest quality it will come across to a patient and affect the result of the case presentation.
Stay in your comfort zone – where you have complete certainty that you can deliver the expected result without reservation. Want to do more? Do more CE!
And this idea dovetails with the conversation about fees. If you don’t think you will be receiving a fair fee then it will also come across to the patient. It’s no fun doing a difficult procedure for a reduced fee just to “pay the bills.” It won’t take long for burnout to set in and the whole job starts to become an emotional drain. You’re better off not participating in plans that have low fee schedules that upset you.
To view Part II (Rules 3 & 4) click the link here: Part II